{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Stephen T Valentik","gend":0,"currentgend":"","add":"4 OLD COUNTY RD","city":"Freeport","state":"ME","zip":"04032","dob":"1939-06-07","age":"","mstatus":"","insh":"10000050683","cliId":"","pno":8606789744,"cno":"","email":"paulacorraao@sbcglobal.net","ename":"","eno":"","pphy":"HAMANN, KATHRYN H","ppno":2078282402,"pcpadd":"PO BOX 9746,","pcpcity":"PORTLAND","pcpstate":"ME","pcpzip":"41045040","pcpcounty":"","pcpid":"","pcpname":"MARTINS POINT HEALTH CARE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"103 FARMINGTON CHASE CRES","madd2":"","madd3":"","mcity":"Farmington","mstate":"CT","mzip":"06032","pcpfaxno":2078282433,"pcpnpi":1982030961,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3VC3V93RP71","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D696","R410","R339","I480","R55","I214","E440","N179","S0101XA","R4182","Z743","N3001","D649","S7012XD","D6959","S80911A","S0990XA","I493","I350","Z23","K4090","F0390","I441","I2510","C4441","H25813","N401","I708","I70203","Z7901","E569","R310","N400","M5450","R338","R7989","K5730","N281","M25561","C44311","D034","Z87891","I5033","R102","S7012XA","R319","Z960","U071","R748","N2889","S199XXA","S3991XA","S3993XA","M1711","R059","I724","E782","I351","I422","N3289","K862","I5189","I517","G9340","R413","R238","M25551","N390","L720","M7981","G8911","L821","L578","S8012XA","I5032","I359","E783","G4730","E785","I083","I83891","R809","Z0101","I10","D6869","I4891","Z112","T83198A","S065X0A","Z7409","I499","R1909","H2513","S80211A","A000","Z471","S8002XD","Z96653","S0003XA","Z66","S065XAA","Z1211","N1831","R6889"],"date":["2024-12-26","2024-12-09","2025-06-24","2025-06-04","2025-08-28","2024-11-01","2024-11-04","2024-10-24","2025-08-07","2025-08-07","2025-08-07","2024-11-09","2025-09-12","2024-11-09","2024-11-08","2025-08-06","2025-08-07","2025-08-07","2025-04-17","2024-11-08","2025-02-04","2025-10-17","2025-04-17","2025-04-17","2025-07-08","2025-08-19","2025-06-27","2024-10-18","2024-10-18","2024-07-31","2025-09-23","2024-11-23","2024-11-12","2025-06-27","2025-06-27","2025-06-27","2024-11-14","2024-11-14","2025-08-06","2025-09-16","2025-08-19","2025-10-31","2025-06-04","2024-11-22","2024-11-12","2024-11-12","2024-11-12","2024-10-18","2024-10-12","2024-10-14","2025-10-30","2024-10-11","2024-10-11","2025-08-25","2024-10-11","2024-11-09","2023-11-16","2024-10-14","2023-08-23","2024-11-12","2024-11-12","2024-10-14","2024-10-14","2024-10-15","2024-10-15","2025-07-08","2025-10-07","2025-06-30","2024-11-04","2024-11-09","2025-10-08","2025-08-01","2025-08-01","2024-10-14","2025-04-24","2025-04-24","2025-06-19","2024-11-23","2024-11-23","2023-02-02","2025-10-17","2024-10-24","2023-04-06","2024-12-26","2022-12-15","2022-12-15","2025-02-07","2024-11-08","2025-10-31","2024-11-30","2025-10-30","2024-12-26","2025-09-29","2025-09-16","2025-08-08","2025-10-01","2025-10-01","2025-10-01","2025-08-07","2025-10-31","2025-10-30","2022-11-25","2022-11-16","2022-09-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","FLUZONE HIGH-DOSE 2025-2026","","","Select","Select",""],["","","FINASTERIDE","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","TRAZODONE HCL","","","Select","Select",""],["","","LEVOFLOXACIN","","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","","","Select","Select",""],["","","WARFARIN SODIUM","","","Select","Select",""],["","","ENALAPRIL MALEATE","","","Select","Select",""],["","","TAMSULOSIN HCL","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","JANTOVEN","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","PEG-3350 AND ELECTROLYTES","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}